Study of Diagnostic Importance of Adenosine Deaminase (ADA) Level in Pleural Effusions

Abstract

Introduction: Pleural effusion is the abnormal accumulation of fluid in the pleural space. TB is the most common cause of pleural effusion worldwide (30-60%). The pleural fluid activity of adenosine deaminase (ADA) is one of the best, providing reliable basis for a treatment decision, particularly in excluding the diagnosis of tuberculosis, due to its high sensitivity1. Aims and Objectives: To assess the importance of adenosine deaminase(ADA) level in the diagnosis of pleural effusion. To assess Adenosine Deaminase Activity (ADA) in tuberculosis pleural effusion and assess the sensitivity and specificity of ADA levels. Materials and Methods: This study was performed at the Department of Pulmonary Medicine at tertiary care centre. The study comprised of 75 patients of pleural effusion having Age > 14 years, Clinical and Radiological evidence of Pleural Effusions & Patients willing for ADA examination. Patients having Age > 65 years, minimal nontappable effusion, not giving consent for ADA examination patient were excluded from the study. Detailed history, thorough physical examination, radiological findings, haematological and biochemical findings were recorded in the proforma. Pleural aspiration was performed on all patients. Macroscopic findings, cytological, microbiological and biochemical analysis of pleural fluid were performed in all patients including ADA level. PCR for Mycobacterium tuberculosis was also assessed in pleural fluid. Pleural fluid Adenosine deaminase level was measured by Giusti and Galanti method. Result: In our study out of 45 patients with tuberculosis pleural effusion ADA was more than 40IU/L in 42 (93.33%) and less than40IU/L in 3 (6.66 %) . Our study showed a mean ADA of 107.7 IU/L Using a cut off of greater 40IU/L we got a sensitivity and specificity of 93.3% and 90% respectively and Positive predictive value 93.3% and Negative predictive value 90%. Conclusion: Pleural fluid ADA activity has been shown to be a valuable biochemical marker that has a high sensitivity and specificity for TB diagnosis.

Evaluation of adenosine deaminase activity in serum and pleural fluid of pulmonary tuberculosis patients with pleural effusion

“…29 In present study, the serum ADA activity was significantly increased (p<0.001) in pulmonary tuberculosis patients with pleural effusion when compared to healthy controls, transudative pleural effusion and exudative pleural effusion in conformance with study of Sonone et al 30 In present study, the pleural fluid ADA activity in pulmonary tuberculosis patients with pleural effusion was significantly increased (p<0.001) when compared to transudative and non-tuberculous exudative pleural effusion controls which was in agreement with Sonone et al, Devkota et al, Gupta BK et al, and Lee et al [30][31][32][33] The pleural fluid ADA level rarely exceeds the cut off limit of >40U/L in nontuberculous lymphocytic effusions. 34 In present study, the pleural fluid ADA levels were >40U/L in all 40 cases of pulmonary tuberculosis with pleural effusion. In present study, the pleural fluid ADA levels were significantly higher than serum ADA levels in pulmonary tuberculosis patients with pleural effusion (p <0.001) which was in conformance with studies of Sharma SK et al, and Piras et al 35,36 In present study, the serum ADA activity in treated pulmonary tuberculosis patients was significantly decreased (p<0.001) when compared to pulmonary tuberculosis patients, which was in conformance with Shibagaki T et al, indicating the role of pleural fluid ADA activity as prognostic marker of the disease.…”

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

“…7 2 mL of pleural fluid was collected in a sterile container and was either immediately analyzed or refrigerated at 4 • C and analyzed within two days. An ADA value >40IU/L was taken as a cut off value for diagnosing tubercular effusion 8,9 .…”

Study of 200 Cases of Pleural Fluid

“…Sravan Kumar and Ritesh Agarwal study found poor utility, sensitivity as a diagnostic tool in diagnosing tuberculous and nontuberculous pleural effusion patients in chronic Kidney disease patients compared to DNA PCR. 9 Sachin Kate and B. K. Muthaa et al 10 in their study found a sensitivity and specificity of 93.3% and 90% respectively when ADA levels of 40 IU/L was taken as the criteria for the diagnosis of Tuberculous pleural effusion. Dr. Prabhakarra Rao et al 11 also found Pleural fluid ADA as a very sensitive and specific marker of tuberculous pleural effusion and is simple, inexpensive and rapid.…”